We are contracted with:

• Medicare Part B

• Workers’ Compensation

• Auto insurance claims

We are out-of-network (OON) with all commercial insurance plans. We provide coded superbills for OON services.

• We provide coded superbills for OON services after collecting payment up-front. Payment is due at the time of service.

• If your plan includes out-of-network benefits (most do), your insurance may reimburse a portion of your care.

If your plan does not include out-of-network benefits, your insurance will only contribute if you see an in-network provider.

Medicare Advantage (Part C) is an alternative to traditional Medicare offered through private insurance companies such as UnitedHealthcare, Humana, and Aetna.

While these plans often include additional benefits (like dental, vision, or wellness perks), they function very differently from traditional Medicare Part B—especially when it comes to provider networks and out-of-network coverage.

Key Differences: Medicare Part B vs. Medicare Advantage

Traditional Medicare Part B:

• You can see any provider nationwide who accepts Medicare

• No network restrictions

• Predictable cost structure (typically ~20% coinsurance after deductible)

• We are in-network providers with Medicare Part B

Medicare Advantage Plans:

• Operate as managed care plans (HMO or PPO)

• Require you to see in-network providers for lowest cost

• May require referrals or prior authorizations

• We are typically out-of-network with these plans

What does this mean for your care at our clinic?

If you have a Medicare Advantage plan, your out-of-pocket costs may be significantly higher when receiving care with us.

• Some plans do not offer out-of-network benefits at all

• Others may allow out-of-network care—but with:

  • Higher copays per visit

  • Lower reimbursement rates

  • Additional authorization requirements

Potential Out-of-Network Costs

Depending on your specific plan, you may experience:

• Higher per-visit copays (often $75–$150+ per visit)

• Responsibility for the full cost of care if no OON benefits exist

• Delays or limitations due to authorization requirements

Because each Medicare Advantage plan is different, we strongly recommend contacting your insurance provider to understand your specific benefits.

Important Takeaway

While Medicare Advantage plans can offer added convenience and bundled benefits, they often come with more restrictions and less flexibility—particularly when seeking care outside of a limited provider network.

If maintaining provider choice, continuity of care, and access to specialized services is important to you, understanding these differences is essential when choosing your Medicare coverage.

• In-network providers (INN): Have a contract with your insurance company that dictates pricing and care parameters.

• Out-of-network providers (OON): Do not have a contract with your insurance, allowing for more flexibility in care—but reimbursement varies by your plan.

Out-of-network simply means your insurance reimburses you based on your specific benefits, rather than a pre-negotiated rate.

Our Patients

Our goal is to provide exceptional, individualized care—not volume-driven treatment.

Insurance-based models often require:

• Shorter visits

• Higher patient volume

• Standardized care pathways

We choose to:

• Spend more time with you

• Deliver highly individualized, evidence-based care

• Integrate performance, prevention, and longevity strategies

Our Model of Care

We are not a traditional physical therapy clinic.

We offer a continuum of care that includes:

• Injury rehabilitation

• Performance optimization

• Metabolic and physiological testing (VO₂ max, lactate, etc.)

• Preventative and longevity-focused services

Many of these services are not covered—or are undervalued—by insurance, yet are essential for long-term health and performance.

Our Team & Community

We are committed to:

• Attracting and retaining highly skilled clinicians

• Providing a sustainable, balanced work environment

• Delivering care that reflects the values of our mountain community

Insurance reimbursement has not kept pace with rising costs, and we will not compromise care quality to meet those constraints.

Yes—if your plan has out-of-network benefits.

Most plans will reimburse a portion of:

• Physical therapy services

• Evaluations and follow-up visits

Reimbursement depends on:

• Your deductible

• Your out-of-network coverage percentage

• Your plan’s “allowed amount”

Because there are thousands of insurance plans, we cannot guarantee what your insurance will reimburse.

However, we will always:

• Provide full transparency of our fees

• Accept HSA/FSA funds and provide coded superbills

• Help you understand your potential reimbursement

You are responsible for payment at the time of service.

We believe in clear, upfront pricing so you can make informed decisions about your care—without surprises.

How Our Pricing Works

As an out-of-network provider, our fees are not dictated by insurance companies. This allows us to:

• Deliver longer, one-on-one sessions

• Provide highly individualized, integrative care

• Avoid rushed, volume-based treatment models

You will always know the full cost of care prior to treatment, regardless of insurance reimbursement.

Common Physical Therapy Services

Please note: final pricing may vary slightly based on complexity and clinical needs.

• Physical Therapy Initial Evaluation (60 minutes): $165

• Physical Therapy Follow-Up Treatment (60 minutes): $150

• Performance Session (60 minutes): $150

Specialty & Integrative Services

These services are often not covered by insurance, but are central to our integrative model:

• VO₂ Max Testing: $150–$250

• Lactate Threshold Testing: $120–$200

• Resting Metabolic Rate (RMR): $100–$150

• Comprehensive Performance + Metabolic Package: Custom pricing

What You Pay vs. What Insurance Pays

• Payment is collected at the time of service

• We will submit claims on your behalf for Medicare Part B, worker’s compensation & Auto.

• Your insurance may reimburse you directly based on your out-of-network benefits for all other commercial insurance plans.

We are always happy to provide:

• Superbills for reimbursement

• Guidance on estimating your insurance benefits

Why Pricing Varies in Healthcare

Healthcare pricing can vary due to:

• Complexity of your condition

• Time and expertise required

• Individualized treatment approach

Unlike insurance-based clinics, we are not restricted to standardized billing models—allowing us to tailor care specifically to you.

Your Investment in Care

Our goal is to provide care that is:

• Efficient (fewer total visits, higher value per session)

• Effective (addressing root causes, not just symptoms)

• Preventative (reducing long-term healthcare costs)

Questions?

We encourage open conversations about cost. Our team is happy to walk you through:

• Expected pricing for your plan of care

• Insurance reimbursement estimates

• Package or program options

No surprises—just transparent, high-quality care.

We strongly encourage patients to understand their benefits. Here are the most important questions:

Out-of-Network Coverage

• Do I have out-of-network benefits for physical therapy?

• What percentage is covered?

Deductible & Maximums

• What is my deductible?

• Has it been met?

• Is there an out-of-pocket maximum?

Visit Limits

• Is there a limit on the number of PT visits per year?

Reimbursement Details

• What is the “allowed amount” for physical therapy?

• How much will I be reimbursed per visit?

Payment Logistics

• Will reimbursement be sent to me or directly to the provider?

If your plan does not include OON benefits:

• You would be responsible for the full cost of care

• Insurance will not contribute unless you see an in-network provider

Some patients choose to:

• Use HSA/FSA funds

• Invest directly in their care for higher quality and longer-term outcomes

We believe healthcare should be:

• Proactive, not reactive

• Individualized, not standardized

• Performance-driven, not just pain-focused

Our model allows us to:

• Spend meaningful time with each patient

• Integrate rehabilitation with performance and longevity

• Deliver care without insurance-driven limitations

While we assist with insurance, it is ultimately the patient’s responsibility to understand their individual plan benefits and coverage.

We are always happy to help guide you—but we cannot guarantee reimbursement.

Our team is happy to walk you through your options and help you make the most informed decision for your health and performance.